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made him no longer dangerous as the upas. If he should have another case, let him stop again in time. Certain writers do make a distinction betwixt sporadic cases as non-contagious, and epidemic cases as highly contagious. But, who is he can discriminate in a sporadic case that destroys, and an epidemic one that destroys in an exactly like manner? Whether the woman perish with sporadic or with epidemic childbed fever, the signs, seats, lesions, and results are precisely the same as to the victims, and the power of generating contagion must be ever an identical power. It is useless to cavil with me on the facts. Nothing is more false than what are called facts, since nothing is so difficult as to know what a fact is. The lawyers know this, and even their cross-examinations leave them in so great an ignorance, that the jury vote is always a matter of doubt-and even when given, often wrongfully given. I have carefully read the cases, considered the arguments, and witnessed many of the events upon which so confident a belief of the contagion is founded-and I aver that I do not discover in them any force, that ought to convince me of the contagious nature of the disorder; wherefore I utterly reject and deny the doctrine as one injurious to the profession of medicine, pernicious to the people, by filling the minds of interested parties with alarm, and as propagating, from age to age, a vile demoralizing superstition as to the nature and causes of many diseases.

Should the Student ask me how to explain the curious occurrence of cases in the practice of one medical gentleman, while his neighbor meets with no such cases, I cannot account for so great a mystery; one which evinces rather a strange coincidence of accidents, than a peripatetic causation by the doctor. I prefer to attribute them to accident, or Providence, of which I can form a conception, rather than to a contagion of which I cannot form any clear idea, at least as to this particular malady. To show how such things do happen, I will here relate an incident, which at the time of the occurrence made a powerful impression upon my mind.

A medical gentleman of my acquaintance left a patient whom he had just delivered, and immediately crossed the street, where in a house opposite he delivered another woman very speedily. The lady first mentioned was seized with epidemic childbed fever, and died; the second one got well without the least accident. He was then in the height of an epidemic, which seemed to single him out from among all his brethren as alone doomed to meet with these dreadful cases, of which they had none in their practice. The question may be asked, how happened it that, if he conveyed the poison, he did not convey it to both these women? It is true the Student may reply he was poi

sonous, but only one of the women was susceptible; and the proof that he was poisonous is contained in the fact that he lost sixteen women, whereas other men lost not one. If the Student replies after this manner, let me say that, within a few days after the above-named occurrences, he invited me to visit with him a woman, more than two miles distant from the before-mentioned dwellings, and whom we found moribund with childbed fever. He was greatly affected by thus finding his patient in the article of death, and as we left the door together, he said, "Am I not singularly unfortunate? Here is this poor woman now dying, while in yonder house, a little way off," pointing to it, "lies another patient of mine, who is likewise dying. What a singular coincidence of cases! That case, over yonder, is one of a woman whom I have repeatedly assisted in her labors. A good while ago she sent me a message to engage me to wait upon her about this time. Having heard nothing from her, and being anxious on account of this epidemic, I called at the house to-day, to learn if she was well. I was told that, having been suddenly seized with labor, and rapidly delivered, they had not been willing to trouble me to call. That she had continued quite well for a day or two, but now was very sick, and would be glad to see me. Upon approaching her bedside, I found her irrecoverably ill with childbed fever, and she is actually in a dying state."

Such was the statement of my medical friend; and I have related it in order that I might next ask the Student to see, in the circumstances of the case, the undeniable proof that strange, inexplicable coincidences may cause one medical gentleman to be tracked, as it were, by childbed fever cases, without any complicity of his person or clothing in the causation of them. In this instance, he had not seen the woman until he found her perishing; in the other, if he gave the malady to Mrs. A, and did not give it to Mrs. B, did he communicate it to Mrs. C? and, if he did, where did Mrs. D find it? I said he lost sixteen patients out of a great number. Did he give it to number one? No. Did number one enable him to transfer it to number two? No. Why should the Student believe (he cannot know) that he gave it to number three, since number four unquestionably did not receive it from him? Well, then, if number four did not receive it from him, why should the Student charge him with giving it to five, six, seven, eight, nine, and so on to the last of the melancholy list? For my part, I am sure he neither did nor could communicate it to any body. If the Student still insists that he was the conveyer of the poison, how did he convey it? Had he himself the disease? No. Did he convey it in his clothes, or hair, or scarf-skin, or in his pulmo

nary or cutaneous halitus-which of these? But another friend of mine who had been chased, so to speak, by a series of such cases, seventy in all, left the city, was absent many days, and on returning, shaved his head, got a new wig, new clothes, new gloves, new pencil. He went into a bath, was washed clean, dressed himself, and then visited and assisted a woman in labor who was seized next day and died. Prussic acid, or arsenic, or nicotine, would hardly be more poisonous than such a gentleman, if he was poisonous, which he was not; he was only unlucky in meeting with the epidemic cases. I say he was not poisonous; but, if the Student insists he was poisonous, pray, how was he so? Not in his hair, which was cut off; not in his dress, it was new; not in his health, for he was in good health; everything, except the man, was new. He could not have carried the atmosphere of his last patient's chamber with him to the country, keep it about him like an invisible cloud, during many days; and then, after a bath, carry it into the last patient's chamber to destroy her with exhalations more pestiferous than the breath of Cacus. I have just now, since writing the last sentence, read again the observations upon the contagion of childbed fever, by Dr. Robert Lee, beginning upon page 487 of his admirable Lectures on the Theory and Practice of Midwifery, 8vo. 1844. No author has given or can give a clearer or more candid detail than his of the motives to believe or reject the contagion, as a cause, as far as those motives are discoverable in the observed cases. The esteem and veneration I feel for that wise and good man, Dr. Lee, are so great, that, if I could believe because any living physician believes a dogma, I should believe it because he does. But Dr. Lee does not believe; he only suspects and fears. At page 489, he says of the facts, that, "though they have led me to adopt the opinion that the disease is sometimes communicable by contagion, and sometimes has a connection with erysipelas; they have not, perhaps, been sufficiently numerous, and of so decisive a character, as to dispel every doubt on the subject of its contagious or non contagious nature, and prove that it is a specific inflammation. It is but right to state that, in a vast majority of cases, the disease has occurred, and in the most destructive form, where contagion could not possibly be supposed to have operated as the cause."

Dr. Lee gives a summary of opinions of past writers, whom I shall not cite for want of space in this volume.

I refer to a special work on this subject which I published in 1854, entitled Treatise on Childbed Fever for an elaborate statement of the argument, both for and against the contagion of childbed fever, and I am willing to leave the subject there, for I am persuaded

that if my exposition of the doctrine of this contagion, in that treatise, is insufficient to bring the reader over to my way of thinking, I at least can never convince him, and must be content forever to let him alone in his phantasy.

Let not the Student charge me, then, with ignorance of the facts relative to the so-called contagion of our dreaded disorder. I am by no means ignorant of them as they are stated by numerous authors; and having, moreover, conversed on the subject with many of the most eminent living accoucheurs, both at home and abroad, I am ignorant neither of facts nor opinions; I even wholly reject the conta gion of scarlatina, measles, and pertussis, as I do that of yellow fever and cholera. And I shall here take the liberty to excuse myself to my brethren who have opposite views, beseeching them to observe that, while I contend for the faith I have, I do not condemn them, however I may dissent from their opinions on these points. Let them therefore, in like manner, condemn and confute my opinions on childbed fever contagion, and, if possible, pardon me.

A man living by the edge of a swamp or mill-pond, in September and October, is very likely to have an attack of intermittent fever. A marsh-miasm makes him sick, and that after a particular manner. But what is the marsh-miasm? No man hath answered that question; and yet, everybody agrees there is some unknown relation betwixt the swamp and the morbid phenomena observable in the man, and that unknown relation is expressed in the word miasm. In like manner, a woman delivered in a lying-in ward of the hospital, falls sick with childbed fever. She is the first on the list; but her case may be followed by ten or by two hundred other cases. As to the marsh-miasm, I know it not; I only know that it is; and, in like manner, I know not what the ward-miasm is. I do know, however, that it is. The marsh-miasm makes sick unto death. The wardmiasm makes also sick unto death. A hundred men shall fall sick in the Valteline, or in the Campagna, and a hundred women shall fall sick in the hospital. Which is a contagious cause, and which is not a contagious cause? The Student may say he suspects the warddisease to be contagious, but let him not say that he knows it to be so; яioris and yvwots, belief and knowledge, are very different states of πιστις the human understanding.

γνώσις,

Let him say, if he will, I know that Mrs. A communicated her epidemic childbed fever to Mrs. B, and I know it, because Mrs. A died on Wednesday in the same ward with Mrs. B, who took it and died on Saturday. If the Student should thus speak, I must reply to him that, as he admits it arose spontaneously in Mrs. A, he ought not to

assume that it could not spontaneously arise in Mrs. B. In such a contagious malady as smallpox, if A be sick with it, and B come into his house, and after some days of incubation should fall sick with variola, he has a reasonable inference from A to B, and that inference is confirmed and reduced from belief or probability to knowledge, because he knows he could have taken lymph or pus from A, with which to inoculate B; an inoculation that could scarcely fail to produce smallpox. But, in childbed fever, he can have no such reasonable inference, since he cannot inoculate B with the malady of A, and knows not where to look for any virus, and has not the least notion of what or where the cause is. In smallpox, though he cannot know what the cause is, yet he can and does know where to look for it, and he always finds it combined with or contained in the lymph or pus of a variolous pustule.

Inasmuch as we cannot know what the essence of a miasm or contagion is, we ought to examine ourselves-that is to say, we ought to pry into our understanding, and see, if possible, whether, under these mysterious circumstances, there is not discoverable some principle, some law or fact, whether in our own understanding, or in the nature of the patient, which, being duly comprehended, might lead us to absolute knowledge upon this subject, and so, free us from miserable doubts and misgivings of duty; and to this end, it seems to me that such a self-examination must result in this, namely, that a miasm or a contagion, can act only on the sensitive element of bodies, just as medicines act solely by the impression they make upon the same sensitive element. As medicines do not act upon the dead body, neither can miasms or contagions affect it. Miasms and contagions are in the same category of powers as medicines.

Every person who has paid some attention to what is called method, or classification in Natural History, knows that the whole of the zoological series have been arranged upon the principle of the subordination of the organs.

"Vertebrate animals possess a trunk, on the sides of which all their parts are symmetrically arranged, because their nervous system consists of a central medullary cone, from each side of which proceed, in symmetrical order, the nerves of all the parts. The body of a mollusk is a lump, because its nervous system is confused; the articulates possess a greater degree of symmetry, because their nervous system is, to a certain extent, symmetrical; their body is articulated exteriorly because the nervous system is so within: in fine, even in the radiated animals, the last vestiges of a nervous system, to be traced in them, have the same radiate form which their whole body has."

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